This document discusses the future of intensive care units and information technology. It outlines how precision medicine, big data, medical devices, virtual reality, and the internet of things can transform ICU care. Specifically: - Precision medicine and identifying patient subphenotypes can lead to personalized treatment protocols. Big data from medical devices, images, and sensors can help with this approach. - Medical devices are becoming informatics platforms that can integrate with hospital systems to share vital sign data, detect adverse events, and measure asynchrony during ventilation. - Virtual reality and early neurocognitive rehabilitation are emerging technologies being studied to benefit ICU patients. - The internet of things, smart alerts, and continuous remote monitoring via mobile

1. Dr. Lluís Blanch Torra
Senior Critical Care
Former President of SEMICYUC
WFSICCM Council member
Director of Institut d’Investigació i
Innovació Parc Taulí I3PT
Cairo, 12 January 2017
ICU of the future & Information
technology

3. Intensive Care Med 2016 DOI 10.1007/s00134-016-4525-y
Computer Driven Intensive Care
GeneticAnalysis
“Triage”
Structural & Physiological
Organ Analysis
Organ Reconstruction
and the brain?

4. ICU
of the
Future
by Sonia Touriño

5. THE PRECISION MEDICINEINITIATIVE
Mission statement:
To enable a new era of medicine through research, technology, and policies that empower
patients, researchers, and providers to work together toward development of individualized
care.
- President Obama, January 30, 2015
https://www.whitehouse.gov/precision-medicine

6. Syndromic Medicine: Guidelines
Precision
Medicine
Personalized Medicine
Protocols for Specific Subgroups

7. Phenotype Identification:
Personalized Medicine for ARDS Patients?
Subphenotypes of ARDS:
Severity: oxygenation impairment & PEEP response
Biology: epitelial vs endothelial injury & inflammation
Aetiology: pneumonia, sepsis, disease-like ARDS
Timing: early, late
Imatge appearence: diffuse, local
Combinations of above
Beitler JR et al. Intensive Care Med 2016;42:756-67

8. Differencesin categoricalvariables
based on phenotype assignment
Differencesin the standardized values of each variable by
phenotype on the y-axis,with the individualcontinuous
variables alongthe x-axis

9. JAMA Published onlineSeptember 26, 2016
Invest in and apply the promise of cognitive
computing. With rapidly expanding computing
capability to integrate, process, and assess very large
databases, opportunities develop for accelerated
learning, understanding individual variation, and
developing predictive modeling.

10. Sources of Big Data
of course in the ICU
Iwashyna TJ & Liu V
AnnalsATS 2014;11:1130-5
5Vs: value, volume, variety,
velocity, veracity

11. Turner MC et al AJRCCM Articles in Press. Published on 17-December-2015
Ware LB et al AJRCCM Articles in Press. Published on 17-December-2015
Long-Term Ozone Exposure & Respiratory Diseases

12. Drivers of “Big Data” in Medicine
Biological Processes Are Better Understood
human genome, genetics & response to therapies,
individualised treatment decisions
Growth of Digitised Information
images, reports, lab. results, monitoring sensors
monitors, ventilators smartphones, Fitbit
Cloud-Based IT Solutions
data unified & available in space and time, novel algorithms &
machine learning
Individual Patients = Decision Support
Whole Populations = Population Health
Mathias Goyen 2016

13. Information overload
ICU ITs
Lack of Information !

14. CCM 2013; 41:1502–1510
Physicians use a limited number of clinical information
concepts at the time of patient admission to the ICU.
The electronic medical record contains an abundance
of unused data.
Information
Overload in ICU
Reported frequency of utilization of data
elements in EMR
HR
SpO2
RR
MAP

15. The Connectivity Envelope Includes Hardware
for Source Tracking and Data Acquisition
Halpern NA. Chest 2014;145:903

17. Potentially injurious ventilator settings
for 1 h during the first 3 days of MV

18. Asynchrony Index & Sedation Scale
Representative Patient
0 100 200 300 400 500 600 700 800 900 1000 1100
0
10
20
30
40
50
AI
SAS
Hour
Hours
AI
SAS

19. Summary:
ICU Informatics & Big Data:
Association
Patients ID or patient location
Interoperability
Data generated by one device can be
accessed and used by another
Time Synchronization
Vital for maintaining an electronic flow sheet
and tracking alarms and responses
Medical Devices are Informatics Platforms
Integration with ICU middleware

20. Virtual reality (VR) typically refers to computer technologies that
se software to generate realistic images, sounds and other sensations
that replicate a real or imaginary environment, and simulate a user's
physical presence in this environment, by enabling the user to interact
with this space and any objects depicted therein using
specialized display screens or projectors and other devices.
From Wikipedia

21. Journal of Critical Care (2011)

22. Virtual Reality

23. Early Neurocognitive Rehabilitation in Intensive Care
Project funded by La Marató TV3 2010
Multidisciplinary Team
ENRIC at ClinicalTrials.Gov

24. Philips Dubai 2016

25. Internet of Things
Smart Alerts Linked to Domotics
Clinic BCN

26. Vital signs display
A middleware (Better Care®) provides connectivity to HIS (SAP)

27. Opportunities for the Future of Health
(of course in the ICU)
Joint enterprise of patients & health professionals & others
(cross fertilization) using digital technologies: big data,
connectivity and artificial intelligence
New forms of technology: sensors and mobile apps for
continuous monitoring, early interventions and immediate
corrections
New players: Small start ups (drive innovation) & Google
and Apple (services providers) instead of big manufacturers
(marketing and distribution): collaboration versus competition
Finding successful business models: adding services to the
portfolio, system efficiencies and long term value
In the ICU we must go from
Volume to Value !!

28. ASYNICU group is
supported by:
AVANZA, FIS, MaratoTV3,
CIBERes, I3Parc Tauli and
Better Care S.L.
Thanks to Members of ASYNICU Group!!